|
 
 |
| CASE REPORT |
|
| Year : 2019 | Volume
: 2
| Issue : 1 | Page : 21-27 |
|
Effect of Panchatikta Panchaprasritika Basti (Medicated Enema Therapy) in the Management of Photodermatoses: A Case Study
Pankaj B Rathore, Shital G Bhagiya, Nilesh N Bhatt, Anup B Thakar
Department of Panchakarma, Institute of Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
| Date of Web Publication | 19-Jul-2022 |
Correspondence Address:
Shital G Bhagiya
Department of Panchakarma, Institute of Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2667-0593.351380
Photodermatoses is a skin disease that is caused by exposure to sunlight. People with photodermatoses may develop skin rashes following exposure to the sun. This manifestation is most likely due to an abnormal immune system reaction to the sun. There is no exclusive description for this condition in Ayurveda, but all pathological skin manifestations are described under the heading of Kustha (~skin diseases). As, the symptoms of photodermatoses are predominant in Vata pitta, the condition can be managed accordingly. The present case of Photodermatoses is treated with Panchatikta pancha prasratika basti, topical application of Go-ghrita, and internal administration of Kaishor guggulu and Manjistadi kwatha. Significant relief was found in Kandu (~itching), Daha (~burning sensation), Toda (~pricking sensation), Shyava aruna varnata (~blackish red hyper pigmentation), Rukshata (~dryness), Utsedha (~skin thickening), Srava (~discharge) and Twak nirmochana (~scaling of skin). Considering the satisfactory results in the present case; similar strategies can be adopted in suitable cases of photodermatoses in larger sample size to generate evidences and disseminate usefulness of traditional interventions in the management of photodermatoses.
Keywords: Ayurveda, Basti Karma, Go-ghrita, Kustha.
How to cite this article:
Rathore PB, Bhagiya SG, Bhatt NN, Thakar AB. Effect of Panchatikta Panchaprasritika Basti (Medicated Enema Therapy) in the Management of Photodermatoses: A Case Study. J Ayurveda Case Rep 2019;2:21-7 |
How to cite this URL:
Rathore PB, Bhagiya SG, Bhatt NN, Thakar AB. Effect of Panchatikta Panchaprasritika Basti (Medicated Enema Therapy) in the Management of Photodermatoses: A Case Study. J Ayurveda Case Rep [serial online] 2019 [cited 2023 May 30];2:21-7. Available from: http://www.ayucare.org/text.asp?2019/2/1/21/351380 |
| Introduction | |  |
Though, sunlight is the most visible and obvious source of comfort in the environment; its inappropriate exposure leads to pathologic consequences in individuals with abnormal immune system. Few effects of sun exposure beyond those affecting the skin have been identified, but cutaneous exposure to sunlight is the major cause of human skin cancer and can have immuno-suppressive effects as well.[1] Photodermatoses is a group of disorders caused by an abnormal cutaneous reaction to sunlight especially to its ultraviolet component.[2],[3]
In Ayurveda, skin diseases are described under the broad term Kustha.[4] Excessive Aatapa sevana (exposure to sunlight/heat) is referred to be an etiological factor in the manifestation of Kustha, Vatarakta (~gout) and Visarpa (~erysipelas) etc.[4],[5],[6] The symptoms of photodermatoses are more predominant to Vata-pitta pradhana kustha than Ek kushtha and other conditions viz. Vatarakta and Visarpa. Thus, the treatment modalities of Vata pitta pradhana kustha will be beneficial in such manifestations. Basti (~therapeutic enema) using Panchatikta pancha prasritika yoga is said to be beneficial in managing Vata pitta pradhana kustha, as the components of Basti are Pitta shamaka and in general, it is best treatment option to pacify aggravated Vata.[7]
Conventional medical system advocate using broad spectrum sun-screen lotions, wearing photo-protective clothing, avoiding exposure to sunlight, photo-sensitizer chemicals and drugs etc.,[2] that can provide symptomatic relief. Despite of advancements in the medical field, there are no satisfactory treatment strategies that can manage the condition completely. Treatment approaches emphasized in Ayurveda are useful in such conditions. In this current study, Panchatikta-panchaprasratika basti is used to manage the case of photodermatoses.
| Case Report | | |
A 62 years of old male visited OPD with chief complaints of blackish red skin lesions all over body (~shyava- aruna varna) that are Raukshya (~non-unctous), Parushya (~hardness) and Khara (~roughness). Burning and pricking sensation on exposure to mid-day sun or heat was also complained by the patient that was existing since ten months. Daha (~burning sensation), Kandu (~itching), Twak nirmochana (~scaling of skin), Srava (~discharge) since nine months and Utsedha (skin thickening) since six months were also presented by the patient.
History of present illness
Patient progressively started noticing burning sensation, itching and pricking sensation on exposure to sun on both hands and head since past 10 months. On rubbing the affected part, he started developing erythema and watery discharge. This was noticed by thickening of dorsum of both hands, feet, scalp and face. The case was diagnosed as photodermatoses by a dermatologist, who advised calamine lotion and sun screen lotion for local application with oral anti-histamines. After using for eight months; the patient stopped the treatment, as satisfactory relief in the symptoms was not observed. Consequent to this, the patient visited Panchakarma OPD for the management of the worsening condition.
Sharirika prakriti of the patient was Kapha-vataja with Madhyama bala (~medium physical strength) and has Pravara satva (~good psychological strength). Patient had Krura koshtha (~constipated bowels) with altered appetite since last year.
No history of tuberculosis, diabetes mellitus, hypertension, hypothyroidism, any other surgeries or chronic illnesses were found in patient. No relevant family history was positive for the same disease.
On inspection, reddish black rashes with erythema and scaling on scalp, face, neck, chest, abdomen, upper and lower back, both upper and lower limbs were noticed. Hyperpigmentation and swelling of dorsum of hands and feet, lower part of forearm and leg were observed. On palpation, thick skin with induration on dorsum of hands and feet, lower leg, lower forearm, and roughness of affected skin was noticed.
Treatment
Initially, Deepana, Pachana was planned with Dhanyaka sunthi sidhdha jala. This was followed by a combination of Arogyavardhini vati (250 mg), Gudhuchi churna (3 gm), Khadira churna (3 gm) was given, thrice a day after meal for 42 days. This was followed by Kaishora guggulu (500 mg), twice before meal and Manjisthadi kwatha (10 ml), twice before meal for 64 days. Erandamula shodhana basti in first three days, and in continuation Panchatikta pancha prasritika basti was administered for seven days with above mentioned Shamana chikitsa. Go-ghrita for local application, twice a day after bath was advised to the patient since beginning of the treatment. [Figure 1]
Erandamula Shodhana Basti
For preparation of Basti, 60 ml Madhu (honey), 8 gm Saindhava (rock salt), 50 ml Tila taila (sesame oil), 20 gm Putayavanyadi kalka [Paste of equal parts of Ajamoda (Trachyspermum ammi (L.) Sprague ex Turrill), Madanaphala (Randia dumetorum Lam.), Bilva (Aegal marmelos L.), Kushtha (Saussurea lappa Clarke.), Vacha (Acorus calamus L.), Shatpushpa (Anethum graveolens L.), Nagaramotha (Cyperus scariosus R.Br.), Pippali (Piper longum L.)] and 500 ml of Erandamula kwatha (decoction of Ricinus communis L. root) were mixed by following a specified sequence advocated in the classical literature to prepare a homogenous blend. This was made to luke-warm and administered on empty stomach in the morning using modified Basti yantra (Basti netra along with modified Basti putaka).
Panchatikta Pancha Prasritika Basti
It was prepared by adding 100 ml of Go-ghrita in 400 ml Panchatikta kwatha with 10 gm of Sarshapa kalka (paste of mustard seeds).[7] This was mixed thoroughly and was administered early in the morning on empty stomach after bowel evacuation daily for eight consecutive days. During administration of Basti, patient was advised not to do exertion, consume easily digestible diet, take bath after evacuation of administered Basti material, and not to sleep during day time.
Pathya-Apathya Ahara and Vihara: Patient was advised to avoid direct contact with mid day sun and any type of exertion. 250 ml processed boiled water with 5 gm each of powdered Sunthi (dry ginger) and Dhanyaka (coriander) was advised for drinking for 3 months for Deepana and Pachana (~increase of digestive fire and digestion). Patient was advised to take light digestible diet like Mudga (Phaseolus radiatus Linn.), Audana (~rice), Krishara (~dish of rice and green gram) in meal.
| Results | | |
Patient has started responding to the interventions and by the end of the treatment, all symptoms reduced significantly. Satisfactory results in overall symptoms and in general appearance were observed. Most of the symptoms were subsided after end of the treatment. [Figure 1]a,[Figure 1]b,[Figure 2]a,[Figure 2]b,[Figure 3]a,[Figure 3]b,[Figure 4]a,[Figure 4]b,[Figure 5]a,[Figure 5]b,[Figure 6]a,[Figure 6]b,[Figure 7]a,[Figure 7]b No aggravation in itching, burning sensation, scaling and hyper-pigmentation were observed.
Post prandial blood sugar was 171 mg/dl which was lowered to 129 mg/dl after treatment. Eosinophil count and ESR were 17% and 40 mm/h respectively before treatment, while the after treatment these values were reduced to 6% and 9 mm/h respectively. [Table 1]
| Discussion | | |
The present condition is Vata pitta pradhana kustha.[8] Excessive Aatapa sevana leads to Pitta prokopa, in turn leading to Vata prakopa causing loss of Snigdha (~unctuous) and Drava guna (~liquidity) in the body. Laboratory investigations suggested pre-diabetic condition and raised eosinophils (17%) suggesting allergic history. Erythrocyte sedimentation rate (ESR) was raised to 40 mm/hr suggesting chronicity of the disease.
Normal skin has several molecules that are activated upon sun exposure and undergo chemical reactions – the chromophores that are important for survival under the sun and necessary for our life. Photosensitivity develops when an abnormal chromophore, or a normal chromophore in exaggerated amounts, is present in the skin. When excited by a photon, these molecules suffer changes within the molecule itself, often within neighboring molecules, in a cascade of events that result in skin damage and inflammation. This can occur through direct molecular modification or production of free radicals, dependent or not on the oxygen.[9]
In the present case, patient was suffering with Mandagni (~poor digestion and metabolism) since one year, due to which, there is a possibility of formation of endogenous photosensitizer metabolites that works as oxidizing agents or free radicals for the skin tissues, in this way degeneration and damage of skin tissues occurs in UV rays and even in normal sunlight. For breakdown of this etio-pathogenesis; first Agnimandya (~poor appetite) was treated with oral medicines and processed water. As Basti helps in removing Dosha from all over body, Panchatikta pancha prasratika basti was given.
Selection of procedures: Langhana karma has been indicated in Kustha and Chaturvidha samshudhi is a type of Langhana.[10],[11] As patient was Krura koshthi with altered Agni, which is a contraindicated condition for Snehapana; further Vamana and Virechana Karmas can’t be performed without Sneha pana. Most of the symptoms in the current case were of Vata pradhana (~predominant of Vata). Uttarottara rakta and Mamsa dhatu vikriti with involvement of Rasavaha, Raktavaha and Mamsavaha srotodushti was noted. As Basti is the best treatment for Vata pradhana tridosha condition, it was preferred over the other Panchakarma procedures.
Erandamula shodhana Basti: As the patient came with chronic illness with excess of Kleda (~clammy) and Bahudosha (~excessively aggravated dosha). Hence, three Shodhana basti were given to the patient for proper Sroto shodhana.[12]
Panchatikta-pancha prasritika basti: Followed by Erandamula shodhana basti; Panchatikta-pancha prasritika basti that is a non-unctuous medicated enema indicated in the management of Prameha (~diabetes mellitus),
Kustha (~skin disorders) was administered. Besides skin lesions; as the patient appear to be in pre-diabetic stage and with the etio-pathology of Sanga type of Srotodushti (obstruction of channels) in Rasa and Raktavaha srotas with Abhishyanda avastha; Panchatikta—pancha prasritika basti was selected in the treatment.
Possible mode of action of Basti
Kwatha drugs: Drugs used in the Basti are of Tikta rasa pradhana (~predominant of bitter taste) those are Vishghna (~anti-toxin), Kandughna (~anti-pruritic), Kushtaghna (~useful in skin diseases), helps in Twak- mamsa sthirikaranam (~strengthening skin and muscle tissues), act as Deepana (~appetizers) and Aama pachana (~corrects impaired metabolism), Lekhana (~scraping / correcting of obstructed channels) and also helps in eliminating Kleda (~clammy), Lasika (~sticky discharge), Puya (~pus), Sweda (~sweat), Kapha and Pitta dosha.[13] These qualities possibly break the pathology at different levels.
Go-ghrita: Go-ghrita helps in eliminating aggravated Vata-pitta dosha. Ghrita also possesses Rakta vikara hara (~diseases due to impurities of blood), Vrana hara (~wound healing), Agni vriddhi (~improving of digestive functions), Lavanyakara (~charming), Kantikara (~beautifying) etc. properties.[14] Ghrita contains anti- oxidants, including vitamin E and A, and carotenoids, which may be helpful in preventing lipid peroxidation preventing oxidative injury to the body, which in turn helps to rejuvenate the skin.[15],[16]
Kalka: Sarshapa kalka enhances the action of the Basti by its Sukshma (~subtle), Tikshna (~sharp) Guna (qualities) that help in eliminating obstruction of channels and toxins from the channels, ultimately evacuating through enema, giving a space for further formation of Shuddha rasadhatu (~quality nutritive fluid) that help in the formation of healthy skin tissue and skin layers.
Shamana drugs
Arogyavardhni vati, Khadira, Guduchi were given to the patient that are indicated in the management of skin disorders. Manjisthadi kwatha and Kaishora guggulu were selected with the purpose of Rakta shodhana (~rectifying blood and its components).
✓ Arogyavardhini vati: A classical drug of choice for the management of Kushtha. It promotes Deepana -Pachana, Sroto shuddhi (~clears obstruction of body channels) and Mala shuddhi (~removing toxins).[17] It balances the functioning of digestive system in general and hepatic functions in specific. It also does the Pachana of Drava and Kleda and does the Rakta vardhana (~improving blood quality).[18]
✓ Khadira: It has been appreciated for its usefulness in skin diseases. It contains Tikta, Kashaya rasa (bitter and astringent taste) that possesses qualities like Shoshana (~absorption), Vishaghna (~anti- poisonous), Kandughna, Twak-Mamsa Sthirikarana, Ropana (~wound healing), Kleda upashoshana (~drying of exudation) thus helping as Shothahara (~reduction in edema), Twak samkocha and Ropana kara (~contraction and healing of skin).[19],[20]
✓ Guduchi: Another drug of Tikta rasa pradhana and indicated in the management of Kushtha. The drug is Tridosha shamaka, balances all Dosha, Dhatu and known for its immuno-modulatory activity.[21],[22]
✓ Cow Ghee (Go-ghrita): It is Vata-pitta shamaka, thus used for local application on the affected area of skin. It helps in covering the part that may prevent the contact of UV and other radiations. Due to its Vrana ropana property, helps in healing.[14]
| Conclusion | | |
Based upon the symptoms, photodermatoses can be correlated with Vata-pitta pradhana kushtha. Deepana, Pachana through Dhanyaka sunthi sidhdha jala followed by Panchatikta pancha prasratika basti and other Shamana drugs significantly relieved symptoms of Photodermatoses. No adverse effects were noticed during or after the treatment Though, this is a single case study; further well designed studies are needed to be conducted to establish actual efficacy and safety of the procedures and formulations used here.
| References | | |
| 1. | Alexander GM, David RB. Photosensitivity and other reactions to light, solar radiation. In: Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison’s principle of internal medicine, 18th ed. vol. 1, chapter 56. New York: McGraw Hill Professional; 2011. p. 1164.  |
| 2. | Srinivas CR, Sekar CS, Jayashree R. Photodermatoses in India. Indian J Dermatol Venereol Leprol 2012;78(7):1-8. |
| 3. | Lehmann P, Schwarz T. Photodermatoses: diagnosis and treatment. Dtsch Arztebl Int 2011;108(9)135-41. |
| 4. | Acharya JT, editor. Charaka samhita of agnivesha, chikitsa sthana; chapter 7, verse 4-6. New Delhi: Chaukhambha Publications; 2016. p. 450. |
| 5. | Ibidem Chikitsa sthana; chapter 29, verse 10. p. 628. |
| 6. | Ibidem. Chikitsa sthana; chapter 21, verse 16-21. p. 559. |
| 7. | Ibidem. Siddhi sthana; chapter 8, verse 8. p.713. |
| 8. | Ibidem. Chikitsa sthana; chapter 7, verse 34-36. p. 452. |
| 9. | Gonçalo M. Phototoxic and photoallergic reactions. In: Johansen J, Frosch P, Lepoittevin JP, editors. Contact dermatitis. Berlin: Springer, 2010. p. 362. |
| 10. | Acharya JT, editor. Charaka samhita of agnivesha, sutra sthana; chapter 23, verse 25. New Delhi: Chaukhambha Publications; 2016. p. 123. |
| 11. | Ibidem. Sutra sthana; chapter 22, verse 22. p. 121. |
| 12. | Acharya JT, Acharya NR, editor. Sushruta samhita of sushruta, chikitsa sthana; chapter 38, verse 81. Varanasi: Chaukhambha Surabharati Prakashan; 2017. p. 585. |
| 13. | Acharya JT, editor. Charaka samhita of agnivesha, sutra sthana; chapter 26, verse 42. New Delhi: Chaukhambha Publications; 2016. p. 144. |
| 14. | Pandey GS, editor. Bhavmrisha pranita bhavprakash nighantu, ghrita varga; verse 4-6. Varasani: Chaukhambha Bharati Academy; 2015. p. 758. reprint 2015. |
| 15. | Sserunjogi ML, Abrahamsen RK, Narvhus J. A review paper: Current knowledge of ghee and related products. Int Dairy J 1998;8:677-88. |
| 16. | Prasad V, Dorle AK. Evaluation of ghee based formulation for wound healing activity. J Ethnopharmacol 2006;107(1):38-47. |
| 17. | Shastri A, editor. Rasratna samuchchaya of vagbhatacharya; chapter 20, verse 87-93. Varanasi: Chaukhambha Amarbharati Prakashan; 2010. p. 400. reprint 2010. |
| 18. | Pal S, Ramamurthy A, Mahajon B. Arogyavardhini Vati: A theoretical analysis. Journal of Scientific and Innovative Research 2016;5(6):225-7. |
| 19. | Pandey GS, editor. Bhavmrisha pranita, bhavprakash nighantu, vatadi varga; verse 30-32. Varanasi: Chaukhambha Bharati Academy; 2015. p. 513. reprint 2015. |
| 20. | Sengupta A, Nath R. Therapeutic effect of Khadira (Acacia catechu) in ekakustha vis-a-vis (psoriasis). International Journal of Science and Research Methodology 2017;6(3):77-87. |
| 21. | Sinha K, Mishra NP, Singh J, Khanuja SPS. Tinospora cordifolia (Guduchi), A reservoir plant for therapeutic applications: A Review. Indian Journal of Traditional Knowledge 2004; 3(3):257-70. |
| 22. | Pandey GS, editor. Bhavmrisha pranita, bhavprakash nighantu, guduchyadi varga; verse 1-10. Varasani: Chaukhambha Bharati Academy; 2015. p. 257. reprint 2015. |
[Figure 1], [Figure 2]
[Table 1]
|
Search Pubmed for